Puberty – Like an environmental impact statement only moodier
Yes, I really am talking about gender affirming care for kids
Before I start, I’d like to set the stage.
First, this is a long post. It’s okay if it isn’t your jam, my feelings are pretty stable. But it’s a huge issue, and I’m still only scratching the surface. Most importantly, this is an issue I care a great deal about, and I’d like to make my position fully transparent. (Get it? Trans-parent? Transp… yeah, okay, I’ll knock it off now.)
Second, lots of people have lots of feelings about this stuff. From where I sit, it seems like the most vocal individuals and groups are the ones with the least skin in the game. They don’t have trans kids, and many of them want to write trans folx completely out of existence. You won’t find that here. It gets plenty of press elsewhere. More voices from trans families need to be center stage.
Third, it is incredibly challenging for any individual or family, especially one with minors, to be out as transgender in US society today. Being out means possibly being targeted with hatred and violence. It’s risky. I also believe the choice about being out should rest with the trans individual themselves, and lots of kids are too young to provide that type of consent with an understanding of how it could impact them today or in the future. This means that families with trans kids must often keep this information to themselves in most circumstances, most notably in things they publish online. To this end, comments like “As the parent of a trans kid…” can often lead to unintentionally outing someone and should be carefully considered or reworded in such a way as to NOT out someone who cannot provide that consent.
Fourth, as alluded to above, I’m opening comments here to everyone, not just paying subscribers. I originally made this change due to some trolling and bullying that needed to stop, and it worked. But I’m missing out on great dialogue and feedback, and this is me testing the waters to see if folks can find ways to contribute that don’t center on hatred or intolerance. To that end, comments will be removed if they contain anything harmful.
Fifth, when you receive this newsletter as an email, you can reply to that email and your message comes right back to me at transfriend@substack.com. If you’d like to say something but don’t feel comfortable putting it in the comments, I’d be delighted to see it in an email. I will never share anything you email to me without your express, written permission. For families or individuals who may be struggling with these issues, please know that you can reach out to me. That’s the entire reason I am here.
Going to college
Before my kids were born, I went back to college. You could’ve called me a mature student, but if you’ve spent any quality time with me, you’d know that’s a pretty bold statement for somebody who likes to paint his face in fudge icing for a laugh. I was a diligent student, and it helped that I cared a lot about the subject matter. My undergrad studies happened through a remote agreement with a local community college in conjunction with Western Washington University (go Vikings!!).
*Interesting side note, my documents all tell you that I was in the Huxley College of the Environment at Western, but that name was since changed due to the revelation that the Huxley dude that school was named after was also super interested in eugenics and white supremacy. How does this stuff slide for so long before we fix it??*
Toward the end of that education I took a class all about Environmental Impact Studies (EIS) for national and state EPA requirements (often called NEPA and SEPA, respectively). We mocked up an EIS for a local project, which meant completing a draft EIS report and presentation. It took weeks of work, tons of research, meetings galore, and collaboration with a team that was half dedicated and half stoned half of the time (you do the complicated math there).1
In every EIS, the research team must provide project alternatives. These are things like…
Alternative 1 – Build a new trail across bridge A
Alternative 2 – Build a new trail across bridge B with a spur to bridge A
Alternative 3 – No action
Each alternative then gets it’s moment in the limelight within the study where the researchers provide quantitative and qualitative analyses of what those options will mean for cost, for access, for impacts to wildlife and surrounding ecosystems before, during, and after construction. There are lots of details. There are pictures and maps, definitions of habitats for wildlife, water quality testing results and requirements. Ultimately, a presentation like this helps a governing body look at all of the empirical evidence in order to make the best possible decision on how to proceed.
*Please note that a decision is required.*
Here’s where I really want you to pay attention. You see Alternative 3 up there? The one that clearly says “No action”? Focus on that for a moment, and let it sink in. Choosing to take no action is an action. Choosing NOT to decide is a decision.
This is all around us. You don’t have to go to a West Coast school to find it. You make these kinds of decisions in your own life all the time.
Example – A friend has tickets to the Mariner’s game on Friday, but you really hate baseball, and you’d rather sit at home and binge episodes of The Mandalorian while eating an entire container of those peanut butter pretzels from Costco that you love so dearly. But your friend will be bummed if you don’t go. So you *forget* to reply to their text until their patience has run out and they finally take someone else and spare you the agony of a $15 hot dog and a numb backside from sitting through twenty-two innings of snoozefest.2 See, you *decided* not to go. You just chose the “no action” alternative there. The do-nothing move.
Even the “no action” alternative is a decision. In the case of your baseball-loving friend, you’re displacing the burden onto them instead of shouldering it yourself, which is an active decision. (There’s an economics lesson in here that I could really nerd out on, but I’m too kind to include it today.)
I was twelve
That’s when puberty hit me full force. It happens to everyone at a slightly different point, and it’s not even a singular event… More like these protracted phases with complex hormonal shifts and undertones (sometimes megatones, and yes, I know that’s not a word). It was crushing, that moment of dawning realization that I was different, that there was something terribly, horribly wrong with me. It would be thirty more years before I knew the word for that feeling – dysphoria.
Puberty for any kid might be great. It might be terrifying. It might be confusing. It might even be a combination of a bunch of things that change from one day to the next. Hormones are funny3 like that. But for those of us who are transgender and go through a puberty that doesn’t match the way we feel, it can be damaging, isolating, humiliating, and painful. For some folx it’s so bad that they can’t remember it as adults. Their brains wipe those traumatic memories out to protect them.
The following three or four years of my early teen life were difficult to manage. My brain gave me one message, and my hormones sent a chemical argument back the other way. I was caught in a Rock ‘em Sock ‘em Robot war every day.
I didn’t get to decide what puberty I would go through. I was the friend with the baseball tickets who got stiffed and had to make the best out of what I was handed. I was the poo end of the “no action” stick, and it hurt. It sucked. It forever set me on a path in life that I could not un-choose. That puberty gave me physical impacts that prevented me from feeling – really feeling – a hug with my wife and my children until I was 44 years old. It pushed me to the outside of social gatherings as the parent-who’s-not-really-a-mom-and-not-really-a-dad. It fed me jarring dysphoria every time I saw my reflection. It left me with disordered eating and depression and anxiety. It gave me a body that was not completely ME.
What if there had been an option to review my choices before I went through puberty? What if I had been presented with documentation of what changes I could expect in my body and possible alternatives, just in case that endogenous puberty didn’t match my internal sense of self?
Puberty as an Impact Study
If we were to put together a study to examine the options of a person’s puberty, like we might do in defense of transkids in the United States whose rights and access to medical care are currently being restricted or eliminated by state legislation, it would be great to see all of the options. Lay out all of the possible decisions so that everyone could understand the full impact of this type of legislation on the human bodies it is controlling. Maybe it would look something like this.
Alternative 1 – Social transition only
Alternative 2 – Social transition plus puberty blockers
Alternative 3 – Social transition, puberty blockers, hormone therapy
Alternative 4 – No action
Alternative 1 is a simple step for any family to take with a trans or gender-diverse child.4 When a child demonstrates a consistent, insistent, persistent expression of gender that does not specifically align with their assigned birth sex, the easiest and least harmful step their family can take is to help that child socially transition through the use of pronouns that feel right to that child, a name that the family can agree on, and a gender expression (haircut, clothing choice, etc.) that fits the child best. Some families choose to do this only at home, sometimes only within close family or friend groups, and sometimes with schools and the wider outside world. The decisions about where and how this type of social transition will be had can be unique to each family and each child involved. Most importantly, the support provided for a child to socially transition affirms who they are, that they are supported, and that they are loved. Social transition, on its own, is one of the most powerful ways we can support and love trans and gender-diverse children, adolescents, teens, and adults.
Sometimes a social transition is the only thing a person wants or needs to do. Not everyone decides to take other steps in their transition. Social transitions can also change over time. Gender, just like other aspects of people as they grow, is a constantly shifting and evolving quality for many people.
Alternative 2 combines the power of socially transitioning with the pause button of puberty blockers for that child. This is a controversial issue for a lot of people to consider, but modern science has more solid answers than conservatives would have you believe. Puberty blockers come in a variety of methods, all of which are safe and must be monitored by a physician who understands their application and limits. No child stays on blockers for so long that their bodies will be harmed.5 Puberty blockers give families time to think about what their next step should be. They let children grow up a little bit more so that they can be involved in that essential discussion. It gives parents and medical professionals time to help that child and their family understand what different types of puberty will look like and feel in their body. Some kids hit critical points in the puberty timeline before anyone is prepared to make a decision about hormone therapy, and blockers buy families that time. Their effects are completely reversible.
Alternative 3 happens when the child/adolescent/teen and their family decide that hormone therapy is the right path for them. For youth who identify as nonbinary, genderfluid, ambigender, or genderqueer, traditional hormone therapy may or may not fit with their ultimate needs, but there is also great flexibility in how and when hormone therapy can be used for each individual. Overall, the effectiveness of hormone therapy is well documented as positive and beneficial for the vast majority of teens who choose it.
Teens who get access to hormone therapy experience a puberty that matches their internal sense of self. They develop secondary sex characteristics that match those of their peers. They grow and change in normal, self-affirming ways. They have the opportunity to enter adulthood with authenticity, with choices about being visibly out or stealth as needed, and with the best chance to be seen and heard and known for who they are instead of just being seen as “that trans person.” After all, aren’t all of us far more interesting as humans than those pieces of our identity which set us apart from others?
Alternative 4 is incredibly important to understand. This is the no action decision, which is an active decision for that child to go through an endogenous puberty, meaning a puberty corresponding to their assigned sex based on the hormones their body will naturally produce. I have seen in so many arguments against gender affirming care that there is a desire to “let a child go through puberty” as though this is “natural” and “right,” which might not be the case for that individual. It is phrased as a way to abstain from the argument, an inaction where all actions are harmful, a neutral position.
It is not.
When any type of puberty begins, hormones will go to their assigned departments and begin shaping, changing, and molding a person’s physical and chemical nature. Yes, some of these changes cannot be reversed. We cannot really make a 6’4” AMAB individual shorter. Nobody’s making my 5’4” frame any taller.
The argument that cross-sex hormones create “irreversible changes” to a body is exactly the same argument as a trans person saying that our endogenous puberty creates irreversible outcomes we can only modify through surgery…
if we can afford it
if we have insurance that covers it
if we can take the time off work
if we can get the gatekeeper letters to vouch for us
if there is a surgeon nearby
if our bodies can tolerate it
if we have a support system to help us recover
if our families will support us doing it in the first place
if legislation has not outlawed and banned it
So what’s the harm in doing nothing?
It takes so much to undo what an endogenous puberty creates, and some of those things can never really be altered. No amount of testosterone will ever make me taller now that I’m in my 40s. Most of the things that estrogen and progesterone did to my body are permanent. If my parents had understood this when I was twelve, my life might have been completely different. I would look different, I would sound different, I would have learned to interact with my peers differently. I would have been given a better opportunity to blend in as just “one of the guys,” and the choice to be stealth or out would have been a real option. I might never have needed top surgery.6
And to the naysayers, the conservative voices, the people who are not trans and do not have trans children or family members, the ones who are in positions of political power, who wish to prohibit access to any form of transition from social to medical, I’d like to remind you that you got what you wanted out of puberty. And it was only blind luck that gave it to you.
Choice
Who gets to make the decision as to which alternative is right for a given child? Does that decision belong with a state legislature? How did we come to a place where all of the major medical organizations support gender affirming care for transgender people of all ages, and yet politicians feel they know better?
If it was your child, would you want someone else telling you what you can or cannot do to help them? Would you want their very existence up for political debate? Would you even want them to see or know about the radical hatred targeting them? Would you worry for the incredibly high rates of suicide and self-harm that trans youth and teens exhibit? Would you think about the pervasive cultural messages they are faced with every day that isolate them, tell them they don’t belong, and show them that hiding is safer than living out loud?
Would you listen if they try to tell you who they are? Or would you gently stuff them back into a gender box that does not fit? Would you force them to undergo a puberty that might cause them great emotional and physical distress? And if you did, would you then act shocked when they still come out as trans in their twenties, thirties, forties, or later in life?
Regret
“What if hormone therapy means a transkid will never be able to have biological children?!”
Or, what if that person might not choose to be a parent at all?
What if they decide to build a family through adoption? Or surrogacy? Or as a step-parent?
And why is everyone so worried about kids having kids when we could worry, instead, about that individual’s quality of life and freedom to choose their own way in the world?
Please stop promoting a cishet-normative family structure as the *only* way to envision a family or a way to raise children. Please stop insisting that a child’s future value is only in their ability to reproduce. Please stop worrying about lives that are nowhere near existing when there is one right in front of you that needs love and support.
“What if that trans kid regrets transitioning? OMG, detransitioning??”
Hey, be kind. Transitions can take on many shapes and directions. They should be governed by individual choice and (hopefully) supported by loving people in that person’s life.
Should someone (like me) ever decide that testosterone isn’t in the cards anymore, please don’t label me as a detransitioner. Likewise, stop vilifying anyone who does identify in that way. Ultimately, let people choose their own labels (if they even want labels).
And, believe it or not, plenty of people modify all kinds of medications for a variety of reasons, all of which are personal and do not in any way justify restricting access to care *just because someone might feel differently in the future.*
Some surgical procedures can also be modified or reversed, but the rate of regret for gender affirming surgeries is incredibly low. For all the hoops we have to go through, trans people are usually pretty solid in our decisions about medical care.
And in the end, ANYONE might choose a path in life that could lead to regret. Should that make us freeze up? Should we be guided by fear? Should that make us decide NOT TO DECIDE? (You see that? How I tied the whole thing together right there? Slick, right?)
But society is broken
To the folks who would say, “Hey, but a girl can be anything she wants. She can be a tomboy. She can be masculine. Can’t you just be yourself and not have to go through the mess of hormones and surgery and whatever?” Listen, you might be saying that, but society as a whole is not. And you’re definitely not saying it for AMAB7 bodies, or for anyone who is intersex, or for nonbinary people. Also, what your words really mean is this:
You believe that you know more about my body than I do.
You do not believe that I am who I am.
You do not respect my truth.
You intend to invalidate my existence as a transgender person.
To anyone who says out loud that a child of any age cannot know who they are, that they are “too young” to know their innate gender, that their parents should not listen to them, I have a message for you. If a trans child does not know their gender, then how are you okay with a (supposed) cis child knowing theirs? Ah, yes, I get it. Being cis is NORMAL. Being trans is NOT. That is your real message to the world.
No matter who your child is now or in the future, please don’t ever give them the message that they are not normal. That hurts so deeply.
To the parents and families of trans and gender-diverse kids, I see you, and I respect you for the love you show every single day in a world/country/state that isn’t supporting you the way it should. You might feel confused. You might feel overwhelmed. Maybe you’re still searching for that community of families like yours who you can talk to and lean on when things are hard.
My heart beats so loudly for you.
Please don’t give up. Please keep showing up. Act up and act out to get your message through. Be involved where you can, and be quiet when you must to protect yourselves and your families. Don’t feel obligated to lead or to be the token trans family if that isn’t your path. Do what is best for yourselves, and know that you are healing people around you who you may never see or know (like me).
Kids?
I haven’t forgotten you. I see you. I feel your frustration and your fear, and I revel in your joy and playfulness. Focus on that algebra test. Create beautiful art and music for the world. Tell your stories in your own ways, and remember that you are so much more than your gender (but your gender is so cool, too!). I cannot wait to hand this world over to you and see what you build with it.
If you or someone you know needs support, please reach out to the Trevor Project (for teens and youth) or to Trans Lifeline (for adults). Wait times may be longer than usual for both of these resources. Please keep trying. You’re worth it.
Your trans friend,
Robin
If you know me, you could probably guess that I took the lead on the project, organized most of it myself, and then completed the parts that my teammates fell asleep for. We got an A, because duh. I wish someone could teach me how to let things fail.
My sincerest apologies to those of you who actually like baseball. I enjoy playing it, but I have no patience watching it. The only thing worse is golf on TV.
Funny uh-oh, not funny haha.
Please note that I favor the term “gender-diverse” over “gender-nonconforming.” Any “nonconforming” language used promotes “othering,” and implies broadly that the “conforming” expression is the only normal one. Using the term “diverse” allows us to see that gender, like so many things, is a spectrum where there is no “normal,” and there are many different places on that spectrum where any individual might find themselves.
Lupron, in fact, is a drug I was on when I underwent IVF before both of my kids were born. It has a variety of uses, but the temporary suppression of hormones it provides is safe and effective for all of them.
Maybe you’re noticing that I’m not mentioning other surgeries here, and I would urge you to think about information privilege, about whether you really need to know, about how much a trans person should have to divulge to be taken seriously or considered “trans enough.”
(AMAB) Assigned male at birth (based on outward sex).
I adored reading this, Robin. I had to pause a few times because I resonated with it so hard. "It left me with disordered eating and depression and anxiety," "I might never have needed top surgery." Both of those - oof, yes. I have clear memories as a child of euphoria when I was "mis"gendered as a boy and the heartbreak I felt when my mom would correct someone and say I was her daughter, and it still took me until last year to finally use the word trans to describe myself. I've been thinking a lot lately about how things would have or could have been different for me growing up and in my early adult years had someone actually paid attention to things like that euphoria and asked me questions instead of just saying I was a tomboy or I'd grow out of it. It felt so good to read this. The firmness with which you explain the realities of being trans, but also the humor you bring to it! I snorted when I read "'What if that trans kid regrets transitioning? OMG, detransitioning??' Hey, be kind." Thank you for writing this!
Very well explained. Thanks for that.
It’s such a shame people can’t simply have the freedom to be who they are. I hope the day will come when everyone is just respected, no matter what. It’s not that hard, really.